Tuesday, 17 January 2017

Lactose and Dairy Products on a Low FODMAP Diet

By Lyndal McNamara (Dietitian)

It is a common misconception that dairy products should be eliminated when following a low FODMAP diet. The reason for this? Regular dairy products do contain a type of natural sugar called lactose, which yes, is also a type of FODMAP.

The good news is that if you have IBS and are following a low FODMAP diet, you only need to limit lactose if you suffer from lactose intolerance (speak to your dietitian about how this is diagnosed). Not sure what this means? You can learn more about lactose intolerance here.


What if I do have IBS and lactose intolerance?
No worries, you still have quite a few options…
Option 1: Keep having regular, lactose containing dairy
Say what? You might be surprised to know that studies have shown that even people with diagnosed lactose intolerance can still tolerate up to two cups (yes, 500ml!) of regular milk each day.1
But how can this be? Spreading out your regular dairy intake into small portions throughout the day will help you tolerate the lactose better.1 Research has also shown that consuming regular dairy products as part of meal rather than alone will improve tolerance.2 Some studies have even suggested that daily consumption of lactose containing dairy products, in small amounts at first but building up over time, can actually improve your body’s ability to digest lactose.3, 4

Option 2: Choose lactose free dairy products
Fortunately, lactose-free dairy products are now readily available in many countries throughout the world. These are still a great choice if you are super sensitive to lactose, as they contain all of the same important nutrients as regular milk, such as calcium and protein.
What makes these products different is that the lactose they contain has been broken down, making it easier for your body to digest. The downside? If lactose tolerance can be improved with regular lactose consumption, lactose free dairy products won’t help with this. Lactose free products are also generally more expensive than regular dairy products.
Also, some products that are promoted as ‘lactose free’ are naturally low in lactose anyway, so you might unnecessarily be paying more for a specialised product when the regular version is just as good. How do you avoid this? Learn which foods actually contain lactose here.
Option 3: Take a lactose digestion aid
There are several products available to help people with lactose intolerance digest lactose better. These contain the enzyme ‘lactase’ and are usually available in drop or tablet form from most pharmacies. They are best taken in the recommended dose when eating or drinking foods containing large amounts of lactose.


Option 4: Choose lactose free, dairy alternatives
If you are vegetarian or vegan, chances are you are already very familiar with non-dairy milk alternatives. Even if you aren’t, you have probably noticed the huge number of dairy free milks that have hit the supermarket shelves in the past few years. Whilst there are many types of non-dairy milk alternatives available, it is important to remember that if you are replacing regular milk, you also need to replace the nutrients that go along with it.
Unfortunately non-dairy milks do not naturally contain calcium, instead it must be added by the manufacturer. You should also be aware that some manufacturers add no calcium at all, or add it in much smaller amounts than would be found naturally in regular dairy milk. If you do choose a non-dairy milk, make sure to check the nutrition information panel on the packet and try to find a brand that contains at least 200-300mg of calcium per serve.
You should also check the app for suitable non-dairy milk alternatives, as not all types are low FODMAP, even though they don’t contain lactose.
Have more questions? Post them below or comment on the Facebook post and one of our dietitian’s will get back to you.

References:
  1. Suarez FL, Savaiano D, Arbisi P, Levitt MD. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. The American journal of clinical nutrition. 1997;65(5):1502-6.
  2. Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, et al. Systematic Review: Effective Management Strategies for Lactose Intolerance. Annals of Internal Medicine. 2010;152(12):797-803.
  3. Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. The American journal of clinical nutrition. 1996;64(2):232-6.
  4. Hertzler SR, Savaiano DA, Levitt MD. Fecal hydrogen production and consumption measurements. Response to daily lactose ingestion by lactose maldigesters. Digestive diseases and sciences. 1997;42(2):348-53.

13 comments:

  1. I have chosen to go dairy free along with the low FODMAP diet. I am very happy with this choice and find it very easy to stick to this. Lots of products out there :)

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  2. So why is this just coming out now? I have been paying a premium for lactose-free milk and yogurt for 2 years now. And now it seems that I am even more sensitive to it than I was before! I have read so much about how dairy is unhealthy for adults, and I jut don't know what to do. Any clarity is appreciated! (Ps I did go to a dietitian here, but I knew more about the diet than she did, and I specifically sought out one who knew about FODMAPS!

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    1. Hi there, we're sorry if we've created more confusion for you regarding your lactose tolerance. As you can imagine, tolerance to lactose containing foods varies between individuals, whether they are lactose intolerant or not. The Monash cut-off values used to classify foods as low in FODMAPs apply to each FODMAP subgroup (including lactose), but are set conservatively to ensure that a) MOST people tolerate a single serve of a food containing the given FODMAP subgroup, and b) to ensure that people can eat more than one 'green' serve of food at a single sitting. A 1/2 cup serve of milk exceeds our cut-off for a 'green' serve of lactose containing food. Establishing your own personal tolerance to lactose containing foods by working with an experienced dietitian through the rechallenge phase of the diet will help to establish your own personal level of tolerance. As we mention in the blog, it is possible that if you include small amounts of lactose containing foods in your diet regularly, you may improve your tolerance to these foods. I hope this helps. Kind regards, Jane

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  3. Why does the Monash app still give a red light to 1/2 cup of milk???

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    Replies
    1. Hi Sharon, please see reply above to answer your question. Best wishes, Monash FODMAP

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  4. Tahini has plenty of calcium, so do many vegies, especially leafy greens.

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  5. I have a hard time finding lactose free yogurt or cottage cheese ect.. I
    Have found lacross free milk and ice cream. I depend a lot on the lactose pills. They really make a difference on how my belly feels later on that day. Thank you for all the helpful information!

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    1. same here. my country doesnt offer enough options of products lactose free or even many of the vegetables and fruits on the list (i havent seen many of them in my life!)
      its hard for me to follow any good diet...

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  6. Thos ideas is very good. you dont need to eat weight loss pills

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  7. I've tried Alpro lactose free yogurt but it's made from soya beans which are high fodmap! Should I be avoiding this?

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  8. I've just tried Alpro lactose free yogurt but it's made from soya beans which are high fodmap! Should I be avoiding this?

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  9. I've tried Alpro lactose free yogurt but it's made from soya beans which are high fodmap! Should I be avoiding this?

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  10. Now a days milk allergies are increasing in numbers specially lactose allergies, i have been suffered many years.But now a days there are many lactose free product, but in our city we only get lactose free milk nut no othr products like butter, cheese...

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